Saturday, 4 October 2014

Let's not medicalise exercise. Inactivity, not exercise, is risky!

Have you ever been told by a gym to check with your GP first if it is OK to exercise? Wondering how common this is.
— AnneMarie Cunningham (@amcunningham) October 4, 2014

I asked this because it is reported that gyms ask many people, but particularly those with long-term conditions to get advice from a health professional before starting exercise. The wiki 'GANFYD' (Get a note from your doctor) even has a template letter for GPs to use when gyms seemingly insist on a letter from a GP to say that exercise is safe.

The above statement is taken from a leaflet published by ExerciseWorks. The leaflet starts by giving advice on how to start exercising but just over half way through is what seems like a disclaimer advising all who are new to exercise to check with a health professional before starting any new exercise activity.

When I asked @exerciseworks why they advised this, because I could find no basis for it, they said that it was 'industry standard' advice.

@amcunningham that's because that is the industry's guidance. I am not risk averse and covered in liability anyway by insurance...
— Exercise Works! (@exerciseworks) October 4, 2014

I could not establish where this industry standard advice is published but if it becomes available I will publish the link. (edit: thanks to +Lindsay Jordan for directing me to PAR-Q, and info on how its use is suggested by industry training. Note this does not suggest that all people increasing physical activity should see a health professional.) But I am concerned because this not fit with general advice from the NHS or from the Chief Medical Officers of Wales, Scotland, Northern Ireland and England on the safety of exercise. In their document "Start Active, Stay Active' they state that previously inactive people who increase their activity are unlikely to encounter significant risks.

There is therefore no justification for the advice that all who are new to exercise, or even those with longterm conditions, should see a health professional before starting to increase their activity.

If you want to start exercising follow the advice on the NHS Choices website. Exercise in not risky, but inactivity is. If the fitness industry really is advising that you need to see a health professional before starting exercise they need to catch up with the NHS!

EDIT : The Faculty for Sports and Exercise Medicine discuss risk stratification for exercise in this document but this is not referred to in the CMO guidance. I will attempt to update as I find out more!

@amcunningham@FSEM_UK yes. CMO can't detail all the risk...inactivity is the issue. More support for LTC patients where risk is higher
— Niall Elliott (@dundeesportsmed) October 4, 2014

3 comments:

I think I drafted the ganfyd page suggested letter text. It followed somebody being in a position where they would clearly benefit from exercise, but they had raised blood pressure. David Lloyd gym insisted they couldn't use the gym until they'd provided a doctor's letter confirming they were fit to do so; and their GP refused to give them such a note in case they were held liable if something bad happened - despite the fact that the patient would clearly benefit from the exercise...

In any case, providing such a "fit note" is not NHS work, and could lead to patients being charged lots of money by their GP (quite aprightly - GPs have more than enough NHS work to do, and should value their time appropriately).

So I fully agree that it is inappropriate and unnecessary to create this barrier for some patients (quite apart from the difficult position it puts doctors in).

An interesting one. You often see the advice to seek approval from a physician before beginning an exercise programme on American equipment and guidance. This is because they are litigious in a way that the UK isn't. If a parq is used properly that would be fine for PTs.

In the case of gyms, they now use the Health Commitment Statement which was developed a few years back and which puts the onus on the individual rather than the gym. It would probably take a legal test case in the UK to add any further requirement to this.

Not sure if this answers the query exactly; but as always the problem is we are a self-regulating industry. I’m more than happy to discuss this further with you and I can send you a copy of the health commitment statement from ukactive if you’d like to know more.

Hi Anne Marie, In reply to the question raised about the FSEM sponsored Student Exercise Prescription Booklet content: The CMO Physical Activity guidelines are a useful tool for health professionals and the general public to assess optimum levels of regular physical activity. Our Exercise Prescription Booklet contains guidance and information for medical students to learn how to establish history and potential contraindications to some exercise, which is part of exercise medicine best practice. Risk stratification by the fitness industry is not a regulatory requirement, however as a self-governing and risk averse industry, exercise professionals may wish to direct clients to their GP if they are unsure of the medical risks for an individual. The ideal situation would be to have GPs and health professionals well versed in exercise/physical activity medicine, with access to a Consultant in Sports and Exercise Medicine, in order for them to recommend the required level of exercise for those patients in a higher risk category for which physical activity is even more beneficial and for the fitness industry to have closer links with the medical profession. Faculty of Sport and Exercise Medicine UK